US Facilities Research Articles

HIV Stigma in Prisons and Jails: Results from a Staff Survey.

With numerous HIV service gaps in prisons and jails, there has been little research on HIV stigma attitudes among correctional staff. Such attitudes may undermine HIV services for inmates at risk of or infected with HIV. This HIV stigma attitudes survey among 218 correctional staff in 32 US facilities (1) provides an overview of staff's stigma attitudes, (2) reports psychometric analyses of domains in Earnshaw and Chaudoir's HIV Stigma Framework (HSF), and (3) explores differences in stigma attitudes among different staff types. Overall, correctional and medical staff expressed non stigmatizing attitudes toward people living with HIV/AIDS, but perceived that stigma and discrimination exist in others. Factor analyses revealed a three factor structure capturing two mechanisms of the HSF (prejudice, discrimination). Few factor score differences were found by staff type or setting. Implications for correctional HIV services and future research on HIV stigma attitudes are discussed.

Trends in animal use at US research facilities

Minimising the use of animals in experiments is universally recognised by scientists, governments and advocates as an ethical cornerstone of research. Yet, despite growing public opposition to animal experimentation, mounting...

Huber expands capacity for precipitated ATH at US facility

Huber expands capacity for precipitated ATH at US facility

Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: a multi-institution analysis of ‘real world’ data

Background:Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.Methods:The Premier database was queried from 2007–2011 for clinical and cost data for patients undergoing isoAVR. This de-identified database contains billing, hospital cost, and coding data from >600 US facilities with information from >25 million inpatient discharges. Expert rules were developed to identify patients with RAT and those with any sternal incision (aStern). Propensity matching created groups adjusted for patient differences. The impact of surgical approach on outcomes and costs was modeled using regression analysis and, where indicated, adjusting for hospital size and geographical differences.Results:AVR was performed in 27,051 patients. Analysis identified isoAVR by RAT (n = 1572) and by aStern (n = 3962). Propensity matching created two groups of 921 patients. RAT was more likely performed in southern hospitals (63% vs 36%; p < 0.01), teaching hospitals (66% vs 58%; p < 0.01) and larger hospitals (47% vs 30%; p < 0.01). There was significantly less blood product cost associated with RAT ($1381 vs $1912; p < 0.001). After adjusting for hospital differences, RAT was associated with lower cost than aStern ($38,769 vs $42,656; p < 0.01).Conclusions:Outcomes analyses can be performed from hospital administrative collective databases. This real world analysis demonstrates comparable outcomes and less cost and ICU time with RAT for AVR.

Benefits, harms, and costs for breast cancer screening after US implementation of digital mammography.

Compared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear. Using five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs. For every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective. The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities

The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign.

Patterns of Radiation Therapy Practice for Patients Treated for Intact Cervical Cancer in 2005 to 2007: A Quality Research in Radiation Oncology Study

To assess practice patterns and compliance with clinical performance measures for radiation therapy (RT) for patients with intact carcinoma of the cervix. Trained research associates reviewed the records of 261 randomly selected patients who received RT for cervix carcinoma between 2005 and 2007 from 45 facilities randomly selected after stratification by practice type. National estimates of patient and treatment characteristics were calculated from survey data using SUDAAN statistical software. From the survey data, we estimated that only 8% of US facilities treated on average more than 3 eligible patients per year. No small or medium nonacademic facilities in the survey treated more than 3 eligible patients per year. Approximately 65.5% of patients began treatment in a facility that treated 3 or fewer eligible patients per year. Although 87.5% of patients had brachytherapy as part of their treatment, the proportion treated with external beam RT only was about double that estimated from the 1996 to 1999 survey. The use of high-dose-rate brachytherapy sharply increased, particularly in small nonacademic facilities. Overall, patients treated in nonacademic facilities were more likely to have incomplete or protracted treatment; 43% of patients treated in small nonacademic facilities did not have treatment completed within 10 weeks. Also, patients treated in facilities that treated 3 or fewer eligible patients per year were significantly less likely to receive concurrent chemotherapy than were patients treated in other facilities. Survey results indicate a disturbingly high rate of noncompliance with established criteria for high-quality care of patients with cervical cancer. Noncompliance rates are particularly high in nonacademic facilities, especially those that treat relatively few patients with intact cervical cancer.

Life in the danger zone

Instruments for studying microbes under biological containment cannot be readily removed from labs for servicing. A US facility is finding ways around that problem.

Lessons Learned from the Microbial Analysis of the Herschel Spacecraft during Assembly, Integration, and Test Operations

Understanding microbial diversity in spacecraft assembly clean rooms is of major interest with respect to planetary protection considerations. A coordinated screening of different clean rooms in Europe and South America by three German institutes [Deutsches Zentrum für Luft- und Raumfahrt (DLR), Leibniz-Institut DSMZ-Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH (DSMZ), and the Institute of Microbiology and Archaea Center, University of Regensburg] took place during the assembly, test, and launch operations of the Herschel spacecraft in 2006-2009. Through this campaign, we retrieved critical information regarding the microbiome within these clean rooms and on the Herschel spacecraft, which served as a model for upcoming ESA mission preparations. This "lessons learned" document summarizes and discusses the data we obtained during this sampling campaign. Additionally, we have taken the opportunity to create a database that includes all 16S rRNA gene sequences ever retrieved from molecular and cultivable diversity studies of spacecraft assembly clean rooms to compare the microbiomes of US, European, and South American facilities.

Surface clear‐sky shortwave radiative closure intercomparisons in the Weather Research and Forecasting model

The ability of the Rapid Radiative Transfer Model for GCMs (RRTMG) and Goddard shortwave (SW) radiative schemes to reproduce global (GHI), direct (DNI), and diffuse (DIF) fluxes at the surface in clear‐sky conditions is examined within the Weather Research and Forecasting (WRF) modeling framework. The models were forced using measurements of precipitable water and aerosol optical properties from five AERONET sites and were evaluated against high‐quality observations of GHI, DNI, and DIF at four nearby or coincident sites of the SURFRAD network and one at the Atmospheric Radiation Measurement Central Facility in the contiguous US. In addition, the performance has been intercompared against the Dudhia broadband SW parameterization together with a regressive model to calculate DNI and DIF and the top‐class SMARTS2 SW spectral model. The role of aerosols has been investigated by running the models with and without aerosols. All of them have shown outstanding skill at predicting GHI within the range of the expected observational error, regardless of whether aerosol information is provided as input. When aerosol information is not provided, DNI and DIF are affected by strong biases. In contrast, providing observed aerosols as input solves the bias issue for DNI and nearly does for DIF using the RRTMG scheme. The RRTMG has also proven to have high potential skill for long‐term assessment of clear‐sky GHI, DNI, and DIF irradiance, as long as reliable aerosol inputs are provided. Considering its simplicity, the Dudhia scheme has also shown a remarkable ability for solar resource assessment in clear‐sky conditions.

188 From the very small to the very large: challenges in conducting epidemiologic studies of US workers exposed to carbon nanotubes

Presentation Time: 11:00 - 11:30ObjectivesCarbon nanotubes (CNT) and carbon nanofibers (CNF) are among the first nanomaterials to reach commercial use in the US and are also showing evidence of serious...

Denial of Abortion Because of Provider Gestational Age Limits in the United States

We examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities. We compared women who presented for abortion care who were under the facilities' gestational age limits and received an abortion (n = 452) with those who were just over the gestational age limits and were denied an abortion (n = 231) at 30 US facilities. We described reasons for delay in seeking services. We examined the determinants of obtaining an abortion elsewhere after being denied one because of facility gestational age limits. We then estimated the national incidence of being denied an abortion because of facility gestational age limits. Adolescents and women who did not recognize their pregnancies early were most likely to delay seeking care. The most common reason for delay was having to raise money for travel and procedure costs. We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term. Many state laws restrict abortions based on gestational age, and new laws are lowering limits further. The incidence of being denied abortion will likely increase, disproportionately affecting young and poor women.

Henry Gabriel Blosser

Henry Gabriel Blosser

Piecewise exponential models to assess the influence of job-specific experience on the hazard of acute injury for hourly factory workers

BackgroundAn inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration.MethodsUsing a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury.ResultsWe highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change.ConclusionsPiecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models.

The Ralls Case: Lessons for Foreign Investors

In September 2012, for only the second time in history, the President exercised his statutory authorities to prohibit the acquisition of a US company on national security grounds. This matter, involving Chinese-controlled Ralls Corporation, offers valuable lessons for foreign companies contemplating US investments. In particular, the Ralls case highlights the dangers associated with transactions that close without CFIUS consideration, the risks associated with physical proximity to sensitive US facilities, and the benefits of early consultations with experienced CFIUS counsel. At the same time, the Ralls matter does not portend any change in US openness to foreign investment-including from China.

Implications of Common and Special Variation for Occupational Health

Common variation is a statistical process-control term for variability associated with usual operating conditions. Special variation occurs when usual operating conditions are disrupted. The objective was to explore the implications for preventive occupational medicine practice of common and special variation in air-level exposure. Illustrations are derived from US and UK beryllium facility databases. Special variation may be missed in finite sampling sets, giving a very inaccurate indication of the highest air levels experienced on the job. Depending on the toxicologic model, failure to assess special variation influences the meaningfulness of aspects of occupational prevention, from medical surveillance through risk management. Jobs and tasks should be characterized for special variation in addition to traditional air sampling. Both special variation and common variation should be considered in occupational medicine preventive practice.

Understanding and developing quantitative risk criteria

AbstractThere are several factors that make the establishment of risk criteria a daunting task that few want to undertake. Nonetheless, for large global corporations, it is likely that one or more facilities have to meet governmental requirements. For US facilities, there is an incentive to having risk criteria in that it allows greater flexibility in complying with the updated API Recommended Practice 752 on siting of occupied permanent buildings. Having corporate risk criteria is imperative to ensure that facilities and operations that are not in “regulated jurisdictions” have a consistent framework to make risk‐related decisions. Risk criteria range from the use of the traditional risk matrix (consequence vs. likelihood) to the more quantitative risk criteria that include geographic risk (individual risk) and/or societal risk criteria. This article discusses the steps necessary to help companies develop robust defendable risk criteria that facilitate decision making. Potential pitfalls are also presented and discussed including: (a) the potential to develop criteria that are unachievable or too lax, (b) developing criteria that are inconsistent with other established programs in the company, and (c) reconciling the needs between unit level criteria and business or group level criteria. Typical risk‐tolerance criteria, and examples of issues and pitfalls that are commonly faced by companies developing such criteria, are also presented. © 2012 American Institute of Chemical Engineers Process Saf Prog, 2012

Building Sustainable Regional Platforms for Incubating Science and Technology Businesses

The authors explore the role played by science and technology parks (STPs) as regional platforms for incubating science- and technology-based businesses. Using multiple case studies of the more established US and French STP facilities, they provide an analysis of the contributions made by STPs as regional drivers of innovative entrepreneurship. The paper concludes that successful STPs can act as platforms for incubating science and technology businesses. If modern STPs are to emerge as sustainable platforms of incubation, their business models must be responsive to changing contextual needs through the pursuit of realistic goals, providing high-quality value-added services, employing professionally competent management and maintaining financial strength.

Politics and US LNG export projects heat up

AbstractThis summer was a busy time for US liquefied natural gas (LNG) exporters. In June, the tiny Kenai LNG plant, located approximately 60 air miles from Anchorage, Alaska, resumed shipments of LNG to Japan. Kenai LNG, in operation since 1969 and currently the only US facility capable of exporting LNG, had previously been targeted for closure. But in the aftermath of the March 2011 earthquake and tsunami that shut down Japan's Fukushima nuclear power plant, Japan has increased imports of LNG breathing new life into Kenai LNG, at least in the short term.1

Article 12 Comparing Rehabilitation Outcomes Between Older and Younger People With SCI

Examine patient and injury characteristics, post-acute rehabilitation, and outcomes between older people incurring SCI and younger peers. Multi-center prospective observational cohort. Six acute rehabilitation facilities in US. 866 patients admitted to participating centers for rehabilitation following SCI. Not applicable. Length of stay, FIM-motor at discharge and one-year post-injury, discharge locations, and clinical pathway. Study group was divided into four groups based on age at injury: 16-29/30-44/45-60/60+ y/o. People incurring SCI at >60 y/o were likely married, retired/unemployed, with Medicare, and higher education attainment. Their injury was mostly resulted from falls and incomplete in nature. Older group had severe comorbidity, the lowest admission and discharge FIM, and longer LOS. They received less amount of post-acute rehabilitation than younger groups. They spent high proportion of occupational therapy time working on basic skills and less on self-care activities. 80% of the 60+ group and the majority of younger groups went home at discharge. 17.2% older group was discharge to nursing home. The older group demonstrated different clinical pathways in one that 10.8% was discharged to nursing home first then went home at anniversary. While admission FIM-motor was the most significant predictor of discharge and one-year FIM-motor in all groups, there appeared to be other differing factors in regression models in the 60+ group. Older people incurring SCI experienced a different clinical pathway from younger cohorts. Results from the study suggested the need to develop an age-at-injury specific health care planning, specifically, a rehabilitation program tailored to the older cohorts.